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MassHealth
All-Provider Bulletin 262
November 2016
TO: All Providers Participating in MassHealth
FROM: Daniel Tsai, Assistant Secretary for MassHealth
RE: Accountable Care Organization (ACO) Pilot
Background
Starting December 1, 2016, MassHealth will initiate a one-year ACO Pilot program. The program will be comprised of primary care provider-based Pilot ACOs. These ACOs will coordinate care and be accountable for the total cost of care for their attributed members within MassHealth’s Primary Care Clinician Plan (PCC) Plan.
The experience of these Pilot ACOs will enable MassHealth to
• Evaluate and monitor how effectively Pilot ACOs coordinate and integrate the care of their attributed members;
• Learn how Pilot ACO models impact the health and well-being of MassHealth members;
• Determine how MassHealth providers are affected;
• Study the impact on total cost of attributed member’s care; and
• Analyze how ACOs impact MassHealth operations.
With this information, MassHealth will be better prepared for the full ACO implementation anticipated in December 2017. Please visit hhs/masshealth-innovations for details and updates regarding MassHealth’s ACO program and other MassHealth innovation initiatives. To view the recently issued ACO Request for Responses (RFRs), please visit .
Selected Pilot ACOs
As a result of a competitive procurement process, MassHealth has contracted with the following six organizations to participate in the ACO Pilot program starting December 1, 2016 (please refer to the end of the bulletin for a list of participating providers within each ACO):
• Boston Accountable Care Organization
• Children’s Hospital Integrated Care Organization
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MassHealth
All-Provider Bulletin 262
November 2016
Page 2
Selected Pilot ACOs (cont.)
• Community Care Cooperative
• Partners Care Connect
• Steward Medicaid Care Network Inc.
• UMass Memorial Healthcare Inc.
Primary Care Provider Participation and Billing
Primary care providers (PCPs) who participate in the Pilot ACOs must be Primary Care Clinicians (PCCs) in the MassHealth PCC Plan. Each Pilot ACO has identified its PCPs to MassHealth. A list of participating PCC entities for each ACO is included at the end of this bulletin.
Pilot ACOs will not be responsible for directly paying for covered services. PCCs that participate in Pilot ACOs will continue to bill MassHealth and be paid fee-for-service, as they are currently in the PCC Plan.
At the end of the ACO Pilot, MassHealth will conduct a retrospective reconciliation to compare total actual costs of care for each Pilot ACO’s panel of attributed members against total expected costs for each ACO. The Pilot ACOs will share in the savings or losses with MassHealth.
Non-Primary Care Providers Behavioral Health Services and ACO Referral Circles
Pilot ACOs will not be responsible for contracting with a provider network. Members attributed to Pilot ACOs will continue to have access to the full MassHealth provider network of specialists, as they currently do through the PCC Plan. Members attributed to a Pilot ACO will continue to be enrolled in the Massachusetts Behavioral Health Partnership (MBHP) and receive behavioral health services through that network.
Pilot ACOs may identify a list of additional providers of various provider types, with which the ACO has a special relationship. These providers can be included in what is referred to as the ACO’s “referral circle.” The PCC Plan will not require referrals for services provided to ACO-attributed members by providers within the referral circle of the member’s ACO. Referral circles are an optional component of the ACO Pilot model. Pilot ACOs may or may not choose to establish referral circles.
Unless part of the ACO’s referral circle, specialists must continue to comply with the PCC Plan’s referral requirements for services rendered to PCC Plan enrollees. For more information regarding the PCC Plan’s referral requirements, please refer to 130 CMR 450.118: Primary Care Clinician (PCC) Plan.
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MassHealth
All-Provider Bulletin 262
November 2016
Page 3
Member Attribution and Notification
PCC Plan members whose PCC is participating with a Pilot ACO will be attributed to that Pilot ACO. MassHealth will notify PCC Plan members whose PCC is participating in a Pilot ACO. Members will be notified of their ACO attribution prior to December 1, 2016. Members who do not want to participate in the Pilot ACO may choose another PCC that is not participating in a Pilot ACO at any time.
Members should ensure that the PCC they are currently assigned to is the PCC they see for primary care services. If a member receives most primary care services from someone other than their assigned PCC, they should contact MassHealth to change PCCs.
Members can change their PCC by contacting the MassHealth Customer Service Center at 1-800-841-2900 or visiting masshealth (click the “MassHealth Members and Applicants” button on the left and then click the “Enroll in a Health Plan” link).
Additional Information
Additional information on MassHealth’s planned restructuring and payment reforms may be found on the MassHealth Innovations website at hhs/masshealth-innovations.
List of Attributed PCC Entities by ACO
The following PCCs have been identified as participating with the Pilot ACOs. This list is subject to change during the term of the Pilot. Providers should contact the MassHealth Customer Service Center at 1-800-841-2900 or providersupport@ with questions.
Boston Accountable Care Organization
Participating Primary Care Clinician sites include:
Boston Health Care for the Homeless Program/McInnis Health Group
Boston University Affiliated Physicians
Boston University Family Medicine
Child Health Foundation of Boston
Codman Square Health Center
DotHouse Health
Evans Medical Foundation
Greater New Bedford Community Health Center
Greater Roslindale Medical and Dental Center
HealthFirst Family Care Center
Mattapan Community Health Center
Riverbend Medical Group
Signature Medical Group
South Boston Community Health Center
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MassHealth
All-Provider Bulletin 262
November 2016
Page 4
Boston Accountable Care Organization (cont.)
South End Community Health Center
Stanley Street Treatment and Resources - SSTAR Family Healthcare Center
Upham's Corner Health Center
Children’s Hospital Integrated Care Organization
Participating Primary Care Clinician sites include:
Adolescent Young Adult Med at Boston Children’s Hospital
Boston Children's Hospital
Briarpatch Pediatrics
Bridgewater Pediatrics LLC
Greater Lowell Pediatrics
Horizon Pediatrics, Inc.
Martha Eliot Health Center
Plymouth Pediatric Associates LLC
Wareham Pediatric Association
Community Care Cooperative
Participating Primary Care Clinician sites include:
Brockton Neighborhood Health Center
Community Health Center of Cape Cod
The Dimock Center
East Boston Neighborhood Health Center
Edward M. Kennedy Community Health Center
Family Health Center of Worcester
Family Health Center of Worcester (Webster Square)
Gloucester Family Health Center
Holyoke Health Center
Holyoke Health Center (Chicopee Health Center)
Lynn Community Health Center
Market Square Family Health Services (Lynn Community Health Center)
Market Square Family Health Services at Western Ave (Lynn Community Health Center)
North Shore Community Health Center
Peabody Family Health Center
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MassHealth
All-Provider Bulletin 262
November 2016
Page 5
List of Attributed PCC Entities by ACO (cont.)
Partners Care Connect
Participating Primary Care Clinician sites include:
Brigham and Women's Hospital
Brigham and Women’s Physicians Organization
Brookside Community Health Center
Southern Jamaica Plain Health Center
Massachusetts General Hospital
Massachusetts General Physicians Organization
MGH Back Bay
MGH Charlestown Healthcare Center
MGH Revere Health Center
MGH Chelsea Healthcare Center
MGH Everett
MGH Revere Broadway Ave
Newton-Wellesley Ambulatory Services
North Shore Physicians Group
Steward Medicaid Care Network, Inc.
Participating Primary Care Clinician sites include:
Individuals
Andrade, Jorge M., MD
Attar, Laila, MD
Bhatti, Nasir A., MD
Bonnet, Jean S. F., MD
Burns, Paul, MD
Chambers, Natalie MD
Chao, Hanpu, MD
Chapman, Bertrand, MD
Dalton, John W., MD
Dias-Hoff, Lucia, MD
Galizio, Stephen J., MD
Kney, Bradford, MD
Lee, Uhun R., MD
Lee, Walter, MD
Oberti, Frank, DO
O'Connor, James W., MD
Ohri, Goverdhan L., MD
Ohri, Neeta, MD
Ostrov, Julia I., MD
Riad, Mamdouh M., MD
Ruby, Eric J., MD
Santos, Roman N., MD
Schwartz, Melvin J., MD
Sharma, Deepak K., MD
Shih, Shiao-Ang, MD
Steele, James P. Douglas, MD
Tello, Jorge E., MD
Thacker, Neelam M, MD
Tufts, Henry, MD
VandenHeuvel, Cathy L., MD
Vera, Juan C., MD
Welter, Ryan, MD
Zuser, Lydia, MD
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MassHealth
All-Provider Bulletin 262
November 2016
Page 6
Steward Medicaid Care Network, Inc. (cont.)
Organizations
Alexeyenko Medical Associates
Bass River Pediatric Associates
Bolton Primary Care
Bramblebush Pediatrics
Cape Cod Pediatrics LLP
Children's Healthcare, Inc.
Doctors James and Kelly Hoye, Partners in Family Care
Eaton Medical Associates, PLLC
Emerald Physician Services, Inc.
Family Medical Associates PC
Geiger-Gibson Community Health Center
Harbor Community Health Center - Hyannis
Harbor Community Health Center - Plymouth
Harvard Street Neighborhood Health Center
Haverhill Family Practice, LLC
Hawthorn Medical Associates
Highland Pediatrics PC
Internal Medicine Preventive Care
Lawrence Family Doctors
Manet Community Health Center at Hough's Neck
Manet Community Health Center at Hull
Manet Community Health Center at North Quincy
Manet Community Health Center at Snug Harbor
Manet Community Health Center at Taunton
Mill River Pediatrics
Nauset Family Practice
Needham Family Practice Associates, PC
Nepsonet Health Center
New England Allergy, Asthma, Immunology & Primary Care, PC
Pediatric Associates of Fall River, Inc.
Physicians of Cape Cod Hospital
Physicians of Falmouth Hospital
Pleasant Valley Internists
Prima CARE, PC
Prime Medical Associates, LLC
Pulmonary Internists and Consultants
Raynham Taunton Pediatrics
Resil Medical Associates
SMG Branch Internal Medicine
SMG Bridgewater Internal Medicine
SMG Brighton Primary Care
SMG Brockton Cardiology
SMG Brockton Family Medicine
SMG Brockton Internal Medicine
SMG Brookline Primary Care
SMG Carney Hyde Park
SMG Carney Primary Care
SMG Chestnut Green Family Medicine
SMG Compass Medical
SMG Compass Medical, Abington
SMG Compass Medical, Braintree
SMG Compass Medical, East Bridgewater
SMG Compass Medical, Middleboro
SMG Compass Medical, South Easton
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MassHealth
All-Provider Bulletin 262
November 2016
Page 7
Steward Medicaid Care Network, Inc. (cont.)
Organizations (cont.)
SMG Compass Medical, Taunton
SMG Dedham Internal Medicine
SMG Easton Cardiology
SMG Fall River Family Health
SMG Family Medicine at Carney Hospital
SMG Foxboro Family and Internal Medicine
SMG General Surgery
SMG Great Woods Family Medicine
SMG Groton Internal Medicine
SMG Hanson
SMG Infectious Disease at Morton Hospital
SMG Internal Medicine Health Associates
SMG Lunenburg Family Practice
SMG Methuen Family Medicine
SMG Methuen Pediatrics
SMG Middleboro Internal Medicine
SMG Mill River Internal Medicine
SMG Millview
SMG Morton Internal Medicine
SMG Nashoba Family Medicine
SMG New Boston Village Primary Care
SMG New England Family Practice of Andover
SMG Newton Primary Care
SMG Primary Care and Women's Health Haverhill
SMG Primary Care of Southern New Hampshire
SMG Randolph Internal Medicine
SMG Stanton Internal Medicine
SMG Townsend Family Practice
SMG Walpole OB/GYN
SMG Watertown Primary Care & OB/GTN
SMG West Roxbury Internal Medicine
SMG Women's Health at Nashoba Valley
SMG Women's Health Brighton
SMG Wrentham Internal Medicine
Trinity Family Medicine LLC
Tristan Medical, PC
Tural Pediatrics, PC
UMass Memorial Healthcare, Inc.
Participating Primary Care Clinician sites include:
Auburn Internal Medicine
Barre Family Health Center
Benedict Family Medicine
Benedict Internal Medicine
Berlin Internal Medicine
Bolton Family Medicine
Bolton Street Primary Care
Chadwick Square Internal Medicine
Community Health Link Primary Care
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MassHealth
All-Provider Bulletin 262
November 2016
Page 8
UMass Memorial Healthcare, Inc. (cont.)
Community Women's Care
Dennis M Dimitri, MD, Family Medicine
East Douglas Internal Medicine
Family Doctors
Fitchburg Adult Medicine
Fitchburg Family Medicine
Grafton Internal Medicine
Grove Family Medicine
Grove Street Internal Medicine
Hahnemann Family Health Center
Hahnemann Medical Group
Harvard Primary Care
Health Alliance Fitchburg Family Practice
Holden Family Medicine
Infectious Diseases Memorial Campus
Infectious Diseases University Campus
Leominster Internal Medicine
Lincoln OB/GYN
Lincoln Primary Care
Lincoln Street Internal Medicine
Lincoln Street Pediatrics
Lincoln Street Primary Care
Marlborough Family Doctors
Marlborough Internal Medicine
Marlborough Medical Associates
Marlborough Primary Care
Millbury Internal Medicine
Montachusett Internal Medicine
Nashaway Pediatrics–Clinton
Nashaway Pediatrics–Sterling
Northborough Crossing Primary Care
Northborough Medical
Pediatric Primary Care University Benedict
Plumley Village Health Center
Shrewsbury Family Medicine–
24 Julio Drive
Shrewsbury Family Practice–
604 Main Street
Shrewsbury Internal Medicine–
604 Main Street
Shrewsbury Primary Care
South County Pediatrics
Spencer Adult and Pediatric Primary Care
Sterling Family Medicine
Sutton Internal Medicine
Tri River Family Health Center
West Boylston Family Medicine
Westborough Adult and Pediatric Medicine
Westborough Internal Medicine
Winthrop Street Family Medicine
Worcester Internal Medicine–Geriatrics
Worcester Internal Medicine-CMG
Questions
If you have any questions about the information in this bulletin, please contact the MassHealth Customer Service Center at 1-800-841-2900, e-mail your inquiry to providersupport@, or fax your inquiry to 617-988-8974.
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